WORCESTER — Like any psychologist, Dr. Craig Wiener of Worcester was trained to observe. But what he observed 35 years ago while doing postdoctoral work at the Worcester Youth Guidance Center was a little different from what his peers were noticing.

Dr. Wiener's observations concerned children who were diagnosed at that time with minimal brain dysfunction, what we now call attention deficit hyperactivity disorder.

Children with this brain dysfunction had difficulty paying attention, were fidgety, interrupted and acted out in structured settings. This behavior was so pronounced it made it difficult or impossible for these children to succeed in structured settings. The medical community had discovered that different parts of the brain were affected in children who exhibited this behavior.

Dr. Wiener questioned the next assumption: that those brain differences were some kind of impairment. "It didn't establish biological causality," he said.

"We would expect that children behaving differently would show brain responses that are different from others. But we often find that people show different brain responses and brain development depending upon the way they live in the world. If we could change the way these children are behaving during their day-to-day living, we could alter the way their brains are responding and developing," he said.

For Dr. Wiener, it was both the diagnosis and the treatment that raised a red flag.

"These kids were being diagnosed with some kind of organic and biological deficiency," he said. "These children's behavior seemed much more a psychological than a biological problem. While the behaviors were difficult for others, the children often obtained advantages from the behaviors, like getting extra attention, getting extra accommodations from others and being able to avoid activities that they didn't like."

And he thought that putting children on medication was risky and wouldn't help in the long term.

"As it turned out decades later, large-scale studies are now showing that ADHD medications are not yielding impressive longer-term benefits. While the medications help incredibly well in the short term and resolve urgent problems, it is not wise to depend on these medications for longer-term success," Dr. Wiener said.

Dr. Wiener also noticed that the ADHD symptoms weren't always present: "It didn't occur when they were doing something they initiated or enjoyed."

That meant that helping them learn to respond differently when asked to engage in something they didn't inititate and weren't sure they'd enjoy was key; in short, changing behavioral responses — long-term behavioral change — rather than altering brain chemistry temporarily with medication.

Dr. Wiener set out to help children and their families overcome some of the difficulties of this diagnosis with behavioral help rather than medication: teaching parents how to teach their children a different way of living in a world.

"My therapy develops the child's self-managing behaviors and self-reliance, while other therapies focus on controlling the child," Dr. Wiener said.

His methods have been published in his book, "Parenting Your Child with ADHD: A No-Nonsense Guide for Nurturing Self-Reliance and Cooperation."

Dr. Wiener's theories have the potential to change the lives of millions of youths and families in the United States alone.

The Centers for Disease Control statistics estimate that more than 6 million children (about 11 percent of the country's children ages 4 to 17) had a diagnosis of ADHD from a health care provider in 2011.

And those children with a diagnosis of ADHD are likely to be put on medication. The CDC estimates that more than 6 percent of children 4 to 17 were on ADHD medication in 2011, a figure that had been steadily increasing.

Statistics show that boys are more likely than girls to receive the diagnosis, and the average age of diagnosis is 7. For children who are put on medication at such a young age, there is the potential for a long period under medication. And at the end of that period, Dr. Wiener believes, these young people will find themselves no better able to negotiate in the world than when they began if they haven't acquired behavior management skills.

There are, he acknowledges, many forces at play encouraging medicating youths diagnosed with ADHD — parents, doctors, teachers. And many parents and teachers want the problems solved quickly, to help a child be less disruptive in class and at home, to help them get the most out of school.

And there is a problem with advocating any course of treatment that doesn't advocate medication: "It's a counterculture statement," he admits.

But many parents as well, Dr. Wiener has found, are relieved to hear that ADHD doesn't mean their child has a permanent brain dysfunction, but something that can be managed through psychology.

He hopes to begin parenting groups that will help teach parents the skills they need to teach their children a new way of living in the world.

To learn more, visit www.craigwiener.com or attend a talk with Dr. Wiener, "Nurturing Self-Reliance and Cooperation in Your Child with ADHD," at 7 p.m. Jan. 13 at the Shrewsbury Public Library, 609 Main St., Shrewsbury.

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